HMO Networks
Network
HMO Illinois
®
Blue Advantage
HMO
SM
Blue Precision HMO
SM
BlueCare Direct
SM
(with Advocate)
Blue FocusCare
SM
Network Code
HMO ADV BAV BHD BFC
Three-
character
Prex
XOH XOH
XOL On Marketplace
Public Exchange
XOOOMarketplaceandavailable
through BCBSIL
QMD On Marketplace
Public Exchange
QMCOMarketplaceand
availablethroughBCBSIL
GBF
Benet Plans
Utilizing
Network
HMO Illinois
(HMOI) BlueAdvantageHMO
SM
BlueAdvantageHMOValue
Choice
SM
(may utilize the HMOI
ortheBlueAdvantageHMO
networks)
Blue Precision HMO
SM
Metallic
QualiedHealthPlans(QHPs):
Gold,Silver,Bronze.
BlueCare Direct
SM
MetallicQHP:
Gold,SilverandBronze
Blue FocusCare
SM
MetallicQHPs:
Gold,Silver,Bronze.
Network
Summary
Thisextensivenetworkconsists
ofhospitals,ancillaryfacilities,
IndependentPracticeAssociations
(IPAs),primarycarephysicians
(PCPs),andspecialists.Thisisa
managedcarebenetproduct
withafullrangeofcomprehensive
benetsandisconsideredGroup
Approvedwhenmedicalcareis
providedorauthorizedbythe
member’sPCP.
Medicalcarethatisnotprovidedor
authorizedbythePCPisconsidered
Non-Group approved and is not
covered. The only exception is in
the case of a medical emergency.
This smaller HMO network
consistsofhospitals,ancillary
facilities,IPAs,PCPs,and
specialists.Thisisamanaged
carebenetproductwitha
fullrangeofcomprehensive
benetsandisconsidered
GroupApprovedwhenmedical
careisprovidedorauthorized
bythemember’sPCP.
Medicalcarethatisnot
providedorauthorizedbythe
PCPisconsideredNon-Group
approved and is not covered.
The only exception is in the
case of a medical emergency.
ThisnetworkisbuiltotheBlue
AdvantageHMOnetworksfor
the Blue Precision HMO QHPs
purchasedontheMarketplace
PublicExchange.Thisisamanaged
carebenetproductwithafull
rangeofcomprehensivebenets
andisconsideredGroupApproved
whenmedicalcareisprovidedor
authorizedbythemember’sPCP.
Medicalcarethatisnotprovidedor
authorizedbythePCPisconsidered
Non-Group approved and is not
covered. The only exception is in
the case of a medical emergency.
TheAdvocatenetworkconsistof
approximately 7500 professional
providers,13Hospitals,including
AdvocateChildren’sHospital
withtwocampuslocationsand
Advocate’sHomeHealthand
Hospice agencies for transition
fromhospitaltohome.*
BlueCare Direct members may
selfreferwithintheAdvocate
network without a PCP referral
in some instances (self referral
doesnotincludesurgical
proceduresorphysicaltherapy
regimens).There are no out-
of-network benets without
authorization. The only
exception is in the case of a
medical emergency.
BFC Network is a narrow
networkdesignedaroundseveral
physician organizations in Cook
County.Thereareapproximately
3,080professionalprovidersand
13hospitalsutilizedbytheBFC
Network.TheBFCnetworkisa
smaller subset of Blue Precision
HMOnetwork.MetallicBenet
planlevelsareBronze,Silver
andGold.
Medicalcarethatisnot
providedorauthorizedbythe
PCPisconsideredNon-Group
approved and is not covered.
The only exception is in the
case of a medical emergency.
Geographic
Area
DesignatedareasintheStateof
Illinois
DesignatedareasintheState
of Illinois
DesignatedareasintheStateof
Illinois
GoldandBronze:Cook,DuPage
andKane
Silver:Cook,DuPage,Kane,Lake
andMcHenry
Cook County
241971.1221
Thethree-characterprexeslisteddonotrepresentanexhaustivelistingofprexes.Benetsandeligibilityshouldbeveriedforallmemberspriortorenderingservices.
BlueCrossandBlueShieldofIllinois,aDivisionofHealthCareServiceCorporation,aMutualLegalReserveCompany,anIndependentLicenseeoftheBlueCrossandBlueShieldAssociation
NetworksandBenefitPlans
Ifyouhaveanyquestionsorwouldlikeadditionalinformationonthe
BlueCrossandBlueShieldofIllinois(BCBSIL)networkandbenetplans
availablefor2022,visitourmemberwebsiteatbcbsil.comorcontactyour
ProviderNetworkConsultant(PNC).
2022
*AdvocateHealthCareisanindependentlycontractedprovider.